HMO Networks
Network
HMO Illinois
®
Blue Advantage
HMO
SM
Blue Precision HMO
SM
BlueCare Direct
SM
(with Advocate)
Blue FocusCare
SM
Network Code
HMO ADV BAV BHD BFC
Three-
character
Prex
XOH XOH
XOL On Marketplace
Public Exchange
XOOOMarketplaceandavailable
through BCBSIL
QMD On Marketplace
Public Exchange
QMCOMarketplaceand
availablethroughBCBSIL
GBF
Benet Plans
Utilizing
Network
HMO Illinois
(HMOI) BlueAdvantageHMO
SM
BlueAdvantageHMOValue
Choice
SM
(may utilize the HMOI
ortheBlueAdvantageHMO
networks)
Blue Precision HMO
SM
Metallic
QualiedHealthPlans(QHPs):
Gold,Silver,Bronze.
BlueCare Direct
SM
MetallicQHP:
Gold,SilverandBronze
Blue FocusCare
SM
MetallicQHPs:
Gold,Silver,Bronze.
Network
Summary
Thisextensivenetworkconsists
ofhospitals,ancillaryfacilities,
IndependentPracticeAssociations
(IPAs),primarycarephysicians
(PCPs),andspecialists.Thisisa
managedcarebenetproduct
withafullrangeofcomprehensive
benetsandisconsideredGroup
Approvedwhenmedicalcareis
providedorauthorizedbythe
member’sPCP.
Medicalcarethatisnotprovidedor
authorizedbythePCPisconsidered
Non-Group approved and is not
covered. The only exception is in
the case of a medical emergency.
This smaller HMO network
consistsofhospitals,ancillary
facilities,IPAs,PCPs,and
specialists.Thisisamanaged
carebenetproductwitha
fullrangeofcomprehensive
benetsandisconsidered
GroupApprovedwhenmedical
careisprovidedorauthorized
bythemember’sPCP.
Medicalcarethatisnot
providedorauthorizedbythe
PCPisconsideredNon-Group
approved and is not covered.
The only exception is in the
case of a medical emergency.
ThisnetworkisbuiltotheBlue
AdvantageHMOnetworksfor
the Blue Precision HMO QHPs
purchasedontheMarketplace
PublicExchange.Thisisamanaged
carebenetproductwithafull
rangeofcomprehensivebenets
andisconsideredGroupApproved
whenmedicalcareisprovidedor
authorizedbythemember’sPCP.
Medicalcarethatisnotprovidedor
authorizedbythePCPisconsidered
Non-Group approved and is not
covered. The only exception is in
the case of a medical emergency.
TheAdvocatenetworkconsistof
approximately 7500 professional
providers,13Hospitals,including
AdvocateChildren’sHospital
withtwocampuslocationsand
Advocate’sHomeHealthand
Hospice agencies for transition
fromhospitaltohome.*
BlueCare Direct members may
selfreferwithintheAdvocate
network without a PCP referral
in some instances (self referral
doesnotincludesurgical
proceduresorphysicaltherapy
regimens).There are no out-
of-network benets without
authorization. The only
exception is in the case of a
medical emergency.
BFC Network is a narrow
networkdesignedaroundseveral
physician organizations in Cook
County.Thereareapproximately
3,080professionalprovidersand
13hospitalsutilizedbytheBFC
Network.TheBFCnetworkisa
smaller subset of Blue Precision
HMOnetwork.MetallicBenet
planlevelsareBronze,Silver
andGold.
Medicalcarethatisnot
providedorauthorizedbythe
PCPisconsideredNon-Group
approved and is not covered.
The only exception is in the
case of a medical emergency.
Geographic
Area
DesignatedareasintheStateof
Illinois
DesignatedareasintheState
of Illinois
DesignatedareasintheStateof
Illinois
GoldandBronze:Cook,DuPage
andKane
Silver:Cook,DuPage,Kane,Lake
andMcHenry
Cook County
241971.1221
Thethree-characterprexeslisteddonotrepresentanexhaustivelistingofprexes.Benetsandeligibilityshouldbeveriedforallmemberspriortorenderingservices.
BlueCrossandBlueShieldofIllinois,aDivisionofHealthCareServiceCorporation,aMutualLegalReserveCompany,anIndependentLicenseeoftheBlueCrossandBlueShieldAssociation
NetworksandBenefitPlans
Ifyouhaveanyquestionsorwouldlikeadditionalinformationonthe
BlueCrossandBlueShieldofIllinois(BCBSIL)networkandbenetplans
availablefor2022,visitourmemberwebsiteatbcbsil.comorcontactyour
ProviderNetworkConsultant(PNC).
2022
*AdvocateHealthCareisanindependentlycontractedprovider.